Tag Archives: Financial Analyst

Key Medicare Changes for 2025: What You Need to Know

11/2024

By Charlotte Disley and Stetson Ponder

As we look ahead to 2025, some important changes are set to shake up Medicare. It’s crucial to understand how these updates might impact your coverage, costs, and access to healthcare. Here’s a straightforward overview of the upcoming changes that all beneficiaries should keep in mind.

Drug Benefits – Part D

$2,000 Out-of-Pocket Cap – One of the biggest changes in 2025 is the introduction of a $2,000 cap on out-of-pocket costs for Part D prescription drugs. Here’s how it breaks down:

  • Deductible Phase: If your plan has a deductible, you’ll need to spend up to $590 out of pocket before coinsurance kicks in.
  • Coinsurance Phase: After you hit that $590 threshold, you’ll pay 25% of the cost for covered drugs until your total out-of-pocket expenses reach $2,000.
  • Catastrophic Phase: Once you hit the $2,000 cap, you won’t have to pay anything else out of pocket for the rest of 2025.

Payment Plans – Starting in 2025, if you’re enrolled in a Medicare drug plan (or a Medicare Advantage plan with drug coverage), you can opt to spread your out-of-pocket drug payments throughout the year through the new Prescription and Copay Payment Schedule Option. There’s no cost to join, but keep in mind this option won’t lower your total drug costs—it just helps manage your payments better!

However, be aware that these changes might lead to some unexpected shifts. For instance, medications could be reclassified to tiers with higher copayments, or some might not be covered at all. It’s important to do your homework—check which prescriptions are included in your plan and get an estimate of their costs for 2025.

Medicare Advantage Plans – Part C

Increased cost of coverage – Medicare Advantage plans might also see higher costs or fewer coverage options due to expected decreases in government funding. Providers will take on more responsibility for prescription drug coverage under the new $2,000 cap, which could lead to changes in available plans.

Scrutiny of prior authorization policies – There is set to be more scrutiny of prior authorization policies by Medicare, which had seen a rise in denials for coverage in recent years. Medicare Advantage plans will need to assess how their prior authorization policies affect different groups and will be required to make this information publicly available on their websites. Responses to prior authorization requests must be given within seven days, down from the previous 14-day requirement.

Unused Benefits – Starting in July 2025, enrollees will receive notifications about any unused benefits in their plans. With an average of 23 supplemental benefits—like hearing aids, fitness programs, and dental services—available in many plans, it’s essential for participants to be aware of what’s offered. Last year, about 30% of Medicare Advantage plans had unused benefits, underscoring the importance of being proactive in managing your options.

Expanding Support in Other Areas

Enhanced Mental Health Services – The availability of licensed mental health professionals who are covered by Medicare is set to expand. This includes Licensed Mental Health Counselors (LMHCs) and Licensed Marriage and Family Therapists (LMFTs), and addiction counselors. This is a significant step toward improving access to mental health care for Medicare beneficiaries.

Family Caregiver Support – Earlier this year, a new program, Guiding an Improved Dementia Experience (GUIDE), was implemented to support patients with Dementia and their unpaid caregivers. GUIDE offers services including a 24/7 support line, a care navigator to help find medical and community-based services, caregiver training, and up to $2,500 per year for at-home, overnight, or adult day care respite services. Typically, patients and their caregivers won’t face copayments. In 2025, the GUIDE program is set to quadruple in size, serving far more of the population experiencing these challenges.

Stay Informed and Prepared

With these major changes on the horizon for Medicare in 2025, it’s vital for beneficiaries to review their prescriptions and healthcare needs to ensure continued coverage. Staying informed and proactive will empower you to navigate these updates and maximize your Medicare benefits.

Reach Out

If you have any specific questions about your situation or enrollment, please reach out to the Cahaba Team directly and we are happy to provide additional resources for Medicare related inquiries.

Sources

  1. https://www.aarp.org/health/medicare-insurance/info-2024/medicare-changes-coming-in-2025.html
  2. https://www.investopedia.com/major-medicare-changes-for-2025-8713206
  3. https://www.panfoundation.org/everything-you-need-to-know-about-medicare-reforms/
  4. https://www.nerdwallet.com/article/insurance/medicare/medicare-changing-2025
  5. https://www.usatoday.com/story/news/health/2024/10/15/medicare-enrollment-changes-for-2025/75671849007/
  6. https://www.wsj.com/health/healthcare/medicare-plans-are-making-big-changes-for-2025-heres-how-to-navigate-them-5c81fd05

Charlotte Disley and Stetson Ponder are Financial Planning Analysts in the Atlanta office of Cahaba Wealth Management, www.cahabawealth.com.

Cahaba Wealth Management is registered as an investment adviser with the SEC and only transacts business in states where it is properly registered, or is excluded or exempted from registration requirements. Registration as an investment adviser does not constitute an endorsement of the firm by the SEC nor does it indicate that the adviser has attained a particular level of skill or ability. Cahaba Wealth Management is not engaged in the practice of law or accounting. Always consult an attorney or tax professional regarding your specific legal or tax situation. Content should not be construed as personalized investment advice. The opinions in this materials are for general information, and not intended to provide specific investment advice or recommendations for an individual. Content should not be regarded as a complete analysis of the subjects discussed. To determine which investment(s) may be appropriate for you, consult your financial advisor.

Open Enrollment “Checklist”

10/2023

By Charlotte Disley

As we approach year-end, benefit enrollment is at the top of many of our “to-do” lists. It is likely that employers have started sending reminders to enroll in benefits for 2024, and we wanted to provide a “checklist” for some things to be on the lookout for to ensure you and your family are appropriately covered going into a new plan year.

  1. Take note of whether or not you are required to take action during open enrollment

It is not uncommon for current benefit elections to roll over, however, companies often reevaluate their benefit options each year and there is a possibility that insurance carriers and/or plans could change. When this is the case, it is likely that you will need to actively elect the new plans being offered.

  1. Compare important plan information

For your healthcare benefits, take a look at deductibles (costs that you are responsible for before insurance kicks in), co-pays/coinsurance (the amount you pay versus the insurance carrier) and out of pocket maximums (the maximum amount you will pay in a given plan year). If your plan is changing, it is also a good idea to check that your current providers are “in-network” with your new insurance carrier – staying in network often helps to reduce your cost for services!

  1. Check your eligibility for certain savings or spending accounts, such as a Health Savings Account (HSA) or Flexible Spending Accounts (FSA) for healthcare and/or daycare

Be sure to understand how these accounts work, including any contribution limits and their tax benefits. Even if your elections do rollover from last year, contribution limits for HSAs have increased for 2024, so you may no longer “max out” this benefit and therefore need to take action.

  1. Evaluate if your current coverage levels for different benefits still make sense

Open enrollment is a great opportunity to reassess if your current benefits remain suitable, or fill any gaps where other coverage might be lacking. This not only applies to healthcare plan elections; it is also pertinent to coverage such as life insurance, long term disability, and any other supplemental benefits your company may offer. For certain benefits, such as disability pay or life insurance, your company may provide a set level of coverage that is employer paid. However, supplemental coverage above and beyond this could work out to be more or less expensive in the marketplace. This is an area we often discuss with clients to ensure they are appropriately covered for their needs, in the most cost effective manner.

  1. Compare your current coverage to what is being offered next year

Even if providers and benefits are staying the same, insurance costs typically rise year over year. Keep an eye out for increased cost per paycheck so you aren’t caught by surprise in January when your take home pay has changed.

  1. Make sure you complete all the steps for your elections and print a confirmation statement for your records.

Outside of open enrollment periods, there are only certain situations where benefit elections can be changed. This might include starting a new job at a different company, or experiencing a life event such as getting married or having a baby. This is why it is so important to pay attention during the open enrollment period. If you think you made a mistake or missed the deadline to submit your enrollment, reach out to the designated contact within your company (likely the HR or Benefits teams) to see if there is anything that can be done to get this corrected.

Benefits are of great importance when it comes to our financial world, and not being properly covered can become burdensome in the case of having to cover large unexpected healthcare costs, or not having the appropriate life/disability insurance in place. Be sure to take note of any deadlines for enrollment, and try not to wait until the last minute. As always, we are available to answer questions you may have!

Charlotte Disley is a financial planning analyst in the Atlanta office of Cahaba Wealth Management, www.cahabawealth.com.

Cahaba Wealth Management is registered as an investment adviser with the SEC and only transacts business in states where it is properly registered, or is excluded or exempted from registration requirements. Registration as an investment adviser does not constitute an endorsement of the firm by the SEC nor does it indicate that the adviser has attained a particular level of skill or ability. Cahaba Wealth Management is not engaged in the practice of law or accounting. Always consult an attorney or tax professional regarding your specific legal or tax situation. Content should not be construed as personalized investment advice. The opinions in this materials are for general information, and not intended to provide specific investment advice or recommendations for an individual. Content should not be regarded as a complete analysis of the subjects discussed. To determine which investment(s) may be appropriate for you, consult your financial advisor.

Cahaba Welcomes Charlotte Disley

Charlotte Disley
Financial Planning Analyst

We are delighted to share that Charlotte Disley has joined our team as a Financial Planning Analyst in the Atlanta office! Previously, Charlotte spent nearly three years working for the benefits department of Global Payments where she gained a unique understanding of employer provided benefit plans.  We look forward to having Charlotte on the team!

Charlotte was born and raised in England, and moved to the U.S. in 2015 to attend Oglethorpe University. She graduated in 2019, Magna Cum Laude, with a Bachelor’s degree in Psychology and a minor in Business Administration. Alongside her studies, Charlotte was a student-athlete as a member of Oglethorpe’s women’s tennis team. She continues to pursue her passion of playing tennis competitively as a member of an ALTA team in the Atlanta area.

Charlotte currently resides in Brookhaven, GA with her husband Hunter and their cat Luna. In her spare time, she enjoys exploring the Atlanta dining scene, attending sporting events and travelling the world.